Patterns and Predictors of Failure after Curative Resections of Carcinoma of the Ampulla of Vater

From the Departments of Surgery (TT, NK, TK, NO), Pathology (YM), and Internal Medicine (JS), Institute of Clinical Medicine, and Department of Epidemiology and Biostatistics (HT), Institute of Community of Medicine, University of Tsukuba, Tsukuba-Shi; and Department of Surgery (YF), Hitachi Mito General Hospital, Hitachi, Japan.

Address correspondence and reprint requests to: Takeshi Todoroki, MD, PhD, Associate Professor, Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-Shi, 305-8575 Japan; Fax: 81-29-853-3042.

	Abstract

Background: Curative resection does not always equate with long-term survival. The aim was to identify patterns and predictors of failure and independent factors of prognosis after curative resection.

Methods: Sixty-six patients with ampullary carcinoma who underwent surgical intervention were reviewed. Fifty-nine patients underwent pancreaticoduodenectomy. Cox regression analysis, log-rank test, Fisher exact test, or ² test was used.

Results: No patient died as a result of surgery; major complications occurred in three, and the 5-year survival rate after curative resection (n = 55) was 52.6%. Significant survival predictors were preoperative serum carcinoembryonic antigen level; gross tumor appearance; tumor, node, and tumor node metastasis stage; and microscopic lymphatic vessel and venous invasion in the primary tumor. Multivariate analysis demonstrated that lymphatic vessel invasion, tumor, and tumor node metastasis stage were significant independent prognostic factors. No patient experienced locoregional failure alone; all 24 relapsed patients had distant failure, and six of them had both. The liver was the most frequent metastatic organ, followed by nodes, peritoneum, lung, and bone. The carcinoembryonic antigen and carbohydrate antigen levels and lymphatic vessel and venous invasion were significant predictors of distant failure, and the mean time to relapse was 13 (range, 0.7-33) months.

Conclusions: Curative resection is associated with significant survival; however, effective systemic adjuvant therapy is needed to prevent distant failure for patients with elevated carcinoembryonic antigen and carbohydrate antigen levels or positive lymphatic vessel or venous invasion. A 3-year follow-up period would be necessary to document relapses.

Key Words: Ampullary carcinoma, Carcinoma of the papilla of Vater, Curative resection, Patterns of failure, Predictors of metastasis, Prognostic factors.

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